General Update #179 - October 4 & October 5

October 4, 2020

Jess provided care for Joyce all day with Dusty arriving late afternoon once his duties at Kenworthy Performing Arts Centre concluded.

8 a.m. - Bathroom trip. Urinary incontinence requiring diaper and diaper pad insert be changed. Urine passed and small bowel movement. Cleaned wounds and applied fresh barrier cream. Changed Joyce into new clothes.

8:33 a.m. - Vitals taken, blood pressure 166/82, pulse 83, blood glucose level @159.

8:45 a.m. - First half of strawberry Ensure.

8:53 a.m. - Lidocaine patch applied. 

8:55 a.m. - Breakfast (1 scrambled egg, second half of strawberry Ensure). Morning medication (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Potassium, Iron). Breakfast finished ~9:20 a.m.

11 a.m. - Bathroom trip. Minor urinary incontinence requiring diaper pad insert change. Urine and small loose bowel movement passed. 

11:20 a.m. - PT walk post toileting into living room, out to kitchen, and back to recliner. 

11:45 a.m. - Compression stockings put on. Joyce coughing and has runny nose.

1:55 p.m. - Blood glucose level 150.

2 p.m. - Lunch (peanut butter sandwich on wheat bread). 2 Tylenol for pain relief. Lunch finished ~2:50 p.m. and fresh cup of tea provided.

2:55 p.m. - Bathroom trip. Minor urinary incontinence issue requiring new diaper pad insert. Urine passed.

6 p.m. - Bathroom trip without incident. Joyce's left leg pain so bad that she required wheeling out to kitchen via her walker. 

6:46 p.m. - Blood glucose level @ 123. Dinner served (Wendy's hamburger and fries, 1 oz. of ketchup). Evening medication (Carvedilol, Metformin, 2 Tylenol). Dinner finished ~7:45 p.m. with all fries eaten and 1/2 of hamburger finished. Leftovers placed in fridge. 

8:59 p.m. - Bathroom trip without incident. Urine passed. Lidocaine patch removed. 

9:15 p.m. - Bed time. 

Dusty returning to farmhouse tomorrow morning.

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October 5, 2020

Dusty arrived to farmhouse ~9 a.m. after errands and supply purchases in Moscow. Found Joyce awake and alert, sitting hunched over in her recliner, without oxygen line in place. Joyce stated she had taken herself to the bathroom earlier in the morning, passing urine and bowel movement, though she does not recall the time.

9:07 a.m. - Carole (Kindred nurse) called to confirm arrival today to check Joyce at Noon. Dusty informed her that Jay (Kindred PT) will be present around that time (~11:30 a.m. or 11:45 a.m. arrival time) to work with Joyce. Carole adjusted her arrival time to ~12:30 p.m. to 12:45 p.m. to check Joyce.

9:26 a.m. - Vitals taken. Blood pressure 159/94, pulse 82. Blood glucose level at 120.

9:27 a.m. - Breakfast (1/2 banana, 1 hard boiled egg with Mrs. Dash seasoning, 1 slice whole wheat toast with butter, vanilla Ensure). Morning medication (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Iron, Potassium). Breakfast finished ~10:05 a.m.

EMT (bandage) scissors have been obtained and replaced paper scissors in farmhouse bathroom to aid in safe removal of Joyce's soiled diapers.

10:13 a.m. - Bathroom trip, Joyce able to travel under her own power. Minor urinary incontinence requiring diaper pad insert change. Urine and Type 5 bowel movement passed. Wounds cleaned. Short PT walk to kitchen window before Joyce returned to recliner. Compression socks removed (Joyce had been wearing them all night). Epsom salt foot soak setup. Lidocaine patch applied to Joyce's back. Tiger Balm patch applied to Joyce's knee ~10:45 a.m. to provide pain relief. Dusty visited with Joyce about the automated floor cleaner the Moscow Walmart has running around its store.

11:09 a.m. - Scam phone call to farmhouse landline intercepted by Dusty (individual claiming that they had a rebate for Joyce if she wanted to sign up for a medical alert system).

11:33 a.m. - Jay (Kindred PT) arrived to farmhouse, confirmed that he must have just missed Joyce and Dusty last week. Informed Jay about Joyce's left leg pains and its immobility occurring almost once per day. Jay noted and reviewed pain experienced with Joyce - no pain when not using the leg, only when she stands and walks on it. Joyce asked what pain levels she experiences when the leg is in pain, Joyce had difficulty expressing but narrowed pain levels at 8-9 when she is experiencing it. Once Joyce gets off her leg, she says the pain levels fall to nothing. Joyce stated that she felt no pain while Jay touched and pressed the affected areas where Joyce reported pain when she stands/walks. Joyce experienced no pain in left leg as Jay moved her left leg around testing it for sensitivity while she was in the seated position on her recliner. Vitals taken, blood pressure at 145/88. Oxygen level at 78%. Temperature at 98.5 degrees. Jay will bring out KT tape for Joyce on his next trip to see if it provides relief to Joyce's knee. Jay asked Joyce about her sleeping and eating habits - Joyce stated she was sleeping well and the family was "feeding [me]" and "making sure I eat everything." 

Jay worked on leg exercises with Joyce in a seated position on her recliner (resistance, range of motion, endurance @ 15 repetitions). Joyce and Jay discussed Star Trek as they worked on exercises. Joyce commented that her oldest son liked the original series when it was on television and her youngest watched Star Trek: The Next Generation and Star Trek: Deep Space Nine with her as they grew up together. Jay confessed that he did not really watch Star Wars or Star Trek when asked by Joyce if he was familiar with the franchise. Jay noted that Joyce holds her breath when she is performing exercises and needs to breathe. He suspects Joyce may be holding her breath or breathing shallowly when walking or performing tasks that she is concentrating on or requiring exertion or effort and might need to be monitored by family caregivers so she does not become lightheaded and pass out. Joyce tires around 8-9 repetitions of exercises which Jay says is about where she should be getting tired at this stage of PT exercises, especially since she is not doing them everyday due to reported fatigue. Jay explained to Joyce that every rep she does when she doesn't feel like she can do anymore are the better ones as they push her body and make improvements to her muscles. Jay worked on breathing exercises with Joyce ("Inhale like you're smelling roses, exhale like you're blowing out candles") when she continued to have difficulty with remembering to breathe through exercises and during breaks between exercises. 

Jay reviewed information provided by Dr. Collins to Joyce and Dusty at Joyce's appointment with Moscow Medical last week with Dusty. Walking and standing exercises that were planned were skipped for today and will be attempted next visit. Jay departed around 12:05 p.m. Joyce asked Dusty if he knew who that was and if it was one of his friends. Dusty reminded Joyce that was Jay from Kindred and that he had been out to the house before. Joyce commented that she did not remember him.

Joyce declined bathroom trip, choosing to nap until Carole (Kindred Nurse) arrived as she stated she was "worn out" and "feeling tired." 

12:50 p.m. - Carole (Kindred Nurse) arrived and asked Joyce how she was doing. Joyce replied she does not know. Confirmed that PT arrived to work with Joyce earlier today. Vitals taken on Joyce - temperature 97.7 degrees. Oxygen level at 95% and pulse at 81. Confirmed 2 liter oxygen flow rate. Blood pressure 136/80.  Joyce reported no headache or neck pain, no cough, only slight pain reported. Carole asked if PT or Dr. Collins reported anything with Joyce's left knee and Dusty provided update (Collins thought it was arthritis acting up, Jay will be bringing KT tape to try using at next PT appointment to see if that helps alleviate pain). Carole asked Joyce if she has experienced any dizziness and Joyce stated she had not. Carole asked about previous medical issues raised during her last visit with Joyce (mouth sores, pressure sores on buttocks, diarrhea). Dusty provided update (mouth sores checked by Dr. Collins who recommended saltwater mouth washes and potential dental visit and denture fitment adjustment for Joyce; pressure sores healing well under family care; standard metformin medication most likely causing Joyce's diarrhea and she was switched to the extended release version - family tracking bowel movements and will notify Dr. Collins if diarrhea continues over next two weeks now that Joyce has been switched to extended release version of metformin) Carole updated medication records to reflect change in metformin type. Blood sugar level log reviewed, noted issues with Saturday's spike due to particular meals ingested on that date. Carole confirmed that Joyce was no longer using blood thinners. Carole asked if Joyce has experienced any other issues that should be checked. Dusty brought up Joyce's increased runny nose and coughing fits (as mucous produced does not appear discolored, does not indicate onset of illness - possibly environmentally caused?). Carole confirmed that Kindred nurses will continue arriving to farmhouse once per week through end of October. She or other nurse will contact Dusty to schedule next visit. 

1:06 p.m. - Bathroom trip without incident. Minor incontinence issue that required change of diaper pad insert. Joyce stated that she thought the Tiger Balm patch helped her knee pain, though it was still present. Joyce returned to recliner ~1:20 p.m., oxygen line replaced. Joyce insisted she was not hungry but Dusty was able to negotiate with her to eat something for lunch.

1:30 p.m. - Lunch served (leftover corned beef hash, 2 tablespoons rice pudding, remaining Ensure drink from breakfast). 2 Tylenol provided for pain relief. Lunch finished ~2:15 p.m.

Joyce stretched out prone in her recliner and napped until she woke with a coughing fit ~3:50 p.m.

4:15 p.m. - Joyce had difficulty concentrating/focusing, finally able to be roused enough to travel to bathroom under her own power. Joyce released her bladder as she moved to sit on toilet riser. Dusty cleaned and sterilized toilet riser and bathroom floor.

4:30 p.m. - Joyce returned to recliner, requesting to continue watching nature documentaries on Netflix. Dusty departing farmhouse ~4:35 p.m. to work at his campus office, returning tomorrow morning ~8 a.m. Carol arriving ~5:30 p.m. to provide evening care for Joyce.